Metabolic hyperferritinaemia (MHF) in bariatric surgery candidates: prevalence and cross-sectional associations with liver function and metabolic markers

Metabolic hyperferritinaemia (MHF) is closely linked to obesity and metabolic disorders, yet large-sample quantitative evidence regarding its clinical characteristics and multisystem metabolic correlations in morbidly obese populations remains insufficient. This study aimed to investigate the prevalence of MHF among bariatric surgery candidates and clarify its associations with liver function, glycolipid metabolism, and hematological indicators. A cross-sectional case-control study was conducted on 695 patients scheduled for bariatric surgery. Patients were stratified into MHF and normal iron groups based on gender-specific serum ferritin cut-off values. Independent-samples t-test and Wilcoxon rank-sum test were applied to compare 14 core metabolic and clinical indicators, and correlation analysis was performed to assess the association between ferritin levels and key parameters. The overall MHF prevalence was 18.51%, with a markedly higher rate in males (32.67%) than in females (10.54%) and a significant upward trend with increased BMI. The MHF group exhibited significantly abnormal liver function, glycolipid metabolism, and hematological indices. Serum ferritin showed moderate positive correlations with alanine aminotransferase and γ-glutamyl transferase. MHF is highly prevalent in patients undergoing bariatric surgery and is closely associated with systematic metabolic and hematological abnormalities. Targeted iron regulation may be a promising strategy to alleviate obesity-related metabolic complications, providing novel clinical insights for high-risk population management.